The process of admitting older patients to home health services following hospital discharge represents a vital link in the transition to community based long term care. The purpose of this investigation is to discover the patterns and elements involved in the process of admission of older adults to home health care services and problems inherent in that process, from the perspective of the experiencing persons (patient and family, home health admission personnel, staff nurses and administrators, and hospital discharge planners). The specific aims are: 1) to describe the activities and procedures of the home health care personnel related to the admission process; 2) to describe the patterns and types of information transferred between hospital and home health care agency; 3) to describe the process of transfer of older patients from hospital care to home health care, and the involvement of the patient and family in that process, from their perspective; and 4) to identify and describe problems inherent in the admission process. This investigation is timely and significant because of the impact of the prospective payment system and the demographic trend for increased numbers of older adults who will require home health services following more frequent but shorter hospital stays. The design of the proposed investigation is ethnographic, and will be conducted at two home health agencies, one a free-standing, proprietary agency and the other a hospital-based home health care agency. Methods of investigation include participant observations and non-structured interviews. The P.I. will observe activities, review documents, and interview persons involved in the process. Ethnographic analysis of taped interview transcripts and field notes will be a continuous process, leading to interpretation of the data, development of categories, domains and themes emerging from the data, and writing of an indepth description of the discoveries and understandings about this process from the perspective of those most closely involved. The study is planned to be conducted over two years. The results of this study will be useful to nurses and health professionals involved in planning and implementing long term care. The study will further provide the basis for a large scale national study predicting the influence of selected variables related to hospital discharge and home health admission of the older patient on quality home health services.